A Blog on Healthcare from an Indian perspective

Max Healthcare

While the slug-fest between the government of Delhi and private healthcare providers, the Indian Medical Association/Delhi Medical Association and a completely partisan media continues, one is left wondering about the possible aftermath of this ugly episode. The media will soon move on to other stories and the government having scored some brownie points and having successfully demonstrated its ‘might’ will look at another vote-catching device, only the citizens of Delhi will be stuck with a much worse healthcare system.

Let us look at some of the reasons for this.

With the kind of sheer hostility that is being shown by the consumers towards private healthcare and individual doctors, many are already talking about not accepting seriously sick patients. Their fear is that if the patient dies in the hospital, they will be blamed for the death and they run the very real risk of being publicly abused by vicious and ignorant television anchors, beaten up by patient attendants and may be sacked from their jobs. In an environment where the media and the patients believe that it is the doctor’s job to get them well and that he is fair game if the outcome is not the desired one, we are clearly telling our doctors not to treat patients where there is a risk of failure. This will indeed be very sad because as patients we must give our doctors the confidence and the strength to fight the good fight to the best of their skills and ability. That trust is the very basis of the practice of medicine.

The advent of private healthcare had also seen some of the best and the brightest Indian doctors returning to India to work in these corporate hospitals. The world over, Indian doctors and nurses are recognized for their skills and diligence. There is much demand for them all over the world. The prevailing atmosphere of distrust and antipathy is already making many of them uneasy. Many have started regretting their decision to return and work in India. Many who were contemplating to return would now prefer to stay put. Many who had plans to go abroad for training, would now look at ways to bring their plans forward and try to stay abroad longer. One can hardly blame them.

Private hospitals are beginning to realize that it is far more important to have paperwork and video recordings of their patient interactions rather than a caring system, where people are encouraged to go the extra mile to help a patient. Since, the hospitals are not sure when they may be facing a media or a court trial, they will ensure that they are well protected at all times. This will further push up the cost of private healthcare. The undue activism visible today will end up defeating its own purpose.

Setting up and running hospitals is an expensive proposition. Only investors with very deep pockets can build the required infrastructure and sustain operations till they see profits, which happen years later and are meager in any case. If the local governments pandering to their vote-bases arbitrarily decide to shut down hospitals, why would investors put in money to build healthcare infrastructure in the country? The government spends on healthcare are in any case minuscule and compare poorly even with sub-Saharan Africa. The government hospitals are already over-crowded, mismanaged, filthy and without much accountability. If the private investors decide that investing in healthcare is not well worth the risk, where will the people like you and me go for our healthcare needs? If I was planning to set up a hospital in Delhi today, I would certainly think twice.

Working for some of the leading ”corporate” hospitals in India in the last 15 years, I have had the opportunity to travel the world. Everywhere that I have traveled, I have been uniformly asked one question, which is, how has Indian private healthcare system evolved so well. Considering the country’s other developmental parameters, private healthcare, which attracts patients from all over the world (Max Healthcare received patients from 80 countries across the world this year) stands out. Not only is the quality of health care compares well with the world’s best, the costs are the lowest. Ironically, instead of taking pride in our achievements, we are trying our best to run down our hospitals and the people who work in them.

Private healthcare players in Delhi are quite dumb-founded by the political grandstanding, the unwarranted hostility of an ignorant media and worse of all the support of ordinary citizens to this madness. Are we, the citizens of Delhi willing to pay this kind of steep price just because we believe the half-truths being peddled by self-serving politicians and a biased, unprincipled media?

PS: Might be a good idea to find out where these same politicians and media warriors and their families go to when they need serious healthcare. No prizes for guessing though.

The views expressed are personal.

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I was in Nairobi earlier this month. The occasion was to inaugurate Max Healthcare’s information Center in the city. I was accompanied by our partner based in Dubai and the program consisted of the usual run of the mill stuff. We had a couple of doctors accompanying us for the almost obligatory OPD’s, which were being hosted by a local medical center in the Upper Hill area of Nairobi. In the evening was a small press interaction, where all of us were to make some noises about how we expected to partner with the local medical fraternity in improving healthcare services in Nairobi and other parts of Kenya.

I was quite apprehensive about this. It is a known fact that the local medical community does not much appreciate foreign doctors landing up on their shores under the guise of OPD’s and taking away ‘their’ patients to sundry hospitals abroad. Though, I have never really understood the cause of this antipathy, (after-all only those patients will choose to travel abroad whose medical condition is such that can not be treated locally) I have been told by our Kenyan hosts that this is for real. Thus, I was a little concerned about a media interaction, where I may have to respond to some sensitive questions.

Also, I was worried that we really didn’t have much to share. After all an information centre of an Indian hospital chain is not really the most interesting piece of news even from the point of view of the news starved media of the city. When we reached the venue in the late afternoon, I was relieved to see our guests trickling in, the PR guys were busy settling the media folks down, the atmosphere was convivial and relaxed.

We had lined up the doctors to talk about their specialities (cancer and neuro-surgery), I was to speak briefly about Max Healthcare and our reasons for landing in Nairobi and our partner from Dubai was to talk about their reasons for joining hands with Max in this venture. We also had two patients, who had been treated at our hospitals and had returned home safely with wonderful experiences in Delhi.

We were soon done with our respective spiels and I could feel a sense of disappointment in the room. The journalists had come with hopes of an interesting evening and our stories had hardly set the room on fire. The presentations from the doctors were also a little technical, which too added to the gloom. They had tried hard, however for doctors to speak in front of an audience and not to lapse into medical jargon is an herculean task. The only saving grace seemed to be the booze and the plentiful food.

As the evening wore on, we had John come up to address the media. John is a cancer survivor, full of life and vitality. Earlier in the day, when I had met him he had told me about his struggle with the big C and how he had fought desperately to beat it. He had been treated by Dr. Rudra Acharya, the cancer surgeon who had spoken a while earlier. “I am here to tell you all, that cancer can be beaten, I am a living proof of this” began John. He narrated his ordeal with a great deal of emotions, the hopelessness of a patient diagnosed with cancer, how it hits you and what extra-ordinary courage it takes to fight this uphill battle. John appeared to be a man with a great deal of conviction and perhaps driven by a mission to share his story widely. He spoke eloquently about how he was taken care of by a team of doctors drawn from various cancer sub-specialities, how did they collaborate to ensure he received the most effective treatment and how everything came together in the end to pull him out from a very difficult situation. He was effusive in thanking Dr. Acharya and the team of doctors, who saw him through this very difficult phase of his life and spoke very highly of his experiences in an Indian hospital so far away from Nairobi. Soon he had his wife join him on the podium, and the two held the audience completely enthralled while sharing even small incidents that touched their hearts. ” I am planning to be in Delhi once again in February for my check-ups and this time round my doctors have invited me to stay at their homes. We missed the Taj Mahal the last time round, I sure hope to see it now” said John. He than invited Dr. Acharya to join him and his wife and both of them warmly hugged Dr. Acharya, who seemed a little overwhelmed with all the attention.

The media loved John. They were now firing questions at him and were literally eating out of his hands.

Soon we had our other guest, Omar, on the podium. He wanted to talk about the treatment of his son at Max Hospital in Saket, New Delhi. His 12 year old son had met with a freak accident in school. The child had tried jumping across a barrier, had landed on the edge and ruptured his urinary pipe. Omar had taken his son to at-least half a dozen centres in various parts of Eastern Africa. Nothing had worked till he landed with Prof. Anant Kumar in Delhi. Dr. Kumar took up the challenge and re-constructed the ruptured pipe. Omar had been delighted to see his son recover and for him his Indian sojourn had truly been one of the most rewarding experiences ever. I had met Omar for the first time in the office of Dr. Anant Kumar in Delhi, about two weeks before this press interaction.I had told him of my plans to travel to Kenya and he had volunteered to come and speak about his experiences with the local media. Omar is of Somali descent, not only did he come over to see us and share his story, he helped arrange many Somali TV stations based in Kenya to come for the press conference. He first narrated his story in English for the benefit of the Kenyan media and than for good measure he repeated everything in the local Somali dialect for the Somali audience both in Kenya and back home in Somalia.

John and Omar both did us a great turn, though all they wanted was to help others overcome similar obstacles in their lives. They volunteered to share their stories of difficult times and their struggles and how they found comfort and happiness with a couple of highly skilled doctors and their dedicated teams in a faraway, strange land.

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Many of you would have noticed that I have hardly been writing this year.

Almost a year has gone by, without a single new post on this blog. Some of you might have wondered, where have I been hiding. Well, to tell you the truth, for most of the year I have been incredibly busy, mostly chasing business for Fortis Healthcare. Till recently, I was heading Sales and Marketing there and this involved a lot of travel, a daily commute from my home to work and, which would easily top 80 kms a day and would gobble up at least 3 hours on the roads in Delhi. Now, anyone who lives in Delhi, knows what this means both on a good and God forbid on a bad day. All this added up to a 12 plus hours a day of work and travel, which left me no time to do anything else.

And than, there was travel in India and abroad. This in a given month would easily consume a minimum of 10 days. While, I love traveling and usually find it uplifting, it would still leave me with even lesser time home, where I mostly write. While on long plane journeys pretty much around the world, I learnt I could easily read, but unfortunately, I also learnt on these journeys that writing inside an aircraft is not my cup of tea. For me it is a solitary vocation, to be pursued in the privacy of my home.

Thus, over the year, as I read and traveled and toiled at Fortis, I kept accumulating new experiences, great insights and thoughts, that I knew would one day be shared with many of you on this blog.

Last month, I left Fortis, and returned to work at Max Healthcare, which has been a happy hunting ground for me in the past too. Returning to Max Healthcare, also meant less hours commuting to work (the office is 15 minutes away from home), less travel (at least in India, all of our hospitals are in North India, most of them in the National Capital Region) and hence, I am now hopeful of putting together more posts and the output here should go up.

Well, from the point of view of the journey of this blog, this year has just run away too quickly. As I recommence this journey, I shall look forward to your usual comments, feedback and encouragement.

Sincerely,

Anas

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Healthcare organisations, hospitals and the like have long believed that the role of the Marketing function in their organisation is limited to organising health camps, CME’s and marketing communication, mostly of the ‘below the line’ variety. Thus the patient information literature that you see in your hospital is largely the doing of the marketing folks, who usually download the basic material from the net, rewrite some of it to make it suitable for their hospital, get the advertising agency to do a layout as per the hospital brand guidelines, get the doctors to approve the medical content and send it for printing. Marketing folks also organise a couple of advertisements usually when the hospital wishes to announce a new celebrity doctor or a new ‘state of the art equipment’, ‘which the hospital acquires. Now lest you misunderstand, this piece is not meant to disparage the role of the marketing folks in a hospital, on the contrary, I believe they have a much greater role to play than customarily assigned to them.

The Marketing function in a hospital has surely to be much more than this. I believe the Marketing team in the hospital must play a critical role in customer engagement. Now you may wonder, if the marketers were to do this, than what would medical folks do? Aren’t they the ones tasked with the responsibility of patient care? Thus, here we must make the distinction between patient care and customer care, which is critical for a hospital. Patient care is the medical care provided to patients in a hospital, which of course is the domain of the doctors, nurses and other medical staff in the hospital. Customer care on the other hand is the sum total of care that hospitals need to deliver to the patient and his attendants, at all the points, where the hospital engages with the customer. In a hospital, the elements of customer care include customer interactions over the phone, on the website, through an advertisement, at the front office, at the billing counters, at the nursing counters, in patient rooms, in doctor’s consult rooms, in the waiting areas, in the cafeterias… really anywhere that the patient or their attendants interact with the hospital.

Most hospitals realise that their biggest asset is a satisfied customer. However, many still believe that a good medical outcome is perhaps the surest way of ensuring a patient’s loyalty. Unfortunately, the modern day patients are far more demanding to be satisfied with just a good medical outcome. In fact, many believe that a positive medical outcome for most procedures and surgeries is a given. What they are really looking for is a great hospital experience, which includes an a lot more than an expected medical outcome. Since, a lot of people still choose a hospital or a doctor based on advise from friends and family, a great customer experience becomes an essential marketing tool.

Let me illustrate the point with a few recent experiences that I have had at Max Healthcare in New Delhi. My father has been battling an oral cancer, and was undergoing radiation therapy at the hospital. Much of the last month I took him to the hospital in the morning everyday. I had requested the hospital to give me a slot early in the morning so that I could go to work later in the day. The hospital obliged without a fuss. Now the General Duty Assistants (GDA’s), who usually wheel patients to the radiation areas report to work at around 8 in the morning and thus I would happily wheel my father over. Imagine, my utter surprise, when the security personnel at the hospital’s gate refused to allow me to do this chore and insisted that he would gladly do it. This was not a one-off, this happened everyday that we went there. A small incident in a hospital’s busy day, but it made all the difference to us, we felt welcomed and cared for. Similarly, many a times in the morning as I waited for my father to finish radiation, I was offered a cup of tea by the staff on duty in the radiation area. Again a small matter, but done instinctively and always with a smile. The fact that I remember these small incidents and write about them here, is excellent marketing for the hospital.

A busy hospital delivers thousands of these experiences every day. Each of them is delivered by individuals, who come from different backgrounds, socio-economic strata, having very differing educational backgrounds, yet they are united at work in aiming to deliver a great customer experience at the hospital. Each of these experiences must exceed customer expectations for them to talk about the hospital and its services.

Many a times a customer experience is delivered even when the customer has not walked into the hospital. These are just as important and include, the effectiveness and ease of handling of the hospital website when the log on to it, the efficiency and knowledge of the telephone operator when they call the hospital and the response of the hospital when in an emergency.

I believe in a new age hospital, the Marketing team must be the custodian of all customer experiences. It should work closely with the hospital operations team in defining the customer engagement paradigm and help them in delivering great customer experiences. The marketing team should have a single goal, to excel in delivering a great customer experience at all customer touch points, whether in the hospital, in the virtual world or outside of the hospital.

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Today is the World No Tobacco Day (WNTD). It is observed every year on May 31st. World Health Organisation started observing WNTD from 1987 and it is promoted globally to create awareness about the perils of tobacco abuse and to encourage people to give up using tobacco.

To commomorate the day, I moderated two panel discussions in New Delhi on the harmful effects of tobacco and how can one kick the habit for good. The panelists were all eminent doctors from Max Healthcare. These included Dr. Sandeep Buddhiraja, who is the Director of Internal Medicine practice at Max Hospitals, Dr. Samir Parikh, who is a well-known psychiatrist and also heads the Mental Health institute at Max Healthcare, Dr. IS Virdi, who is the director of Cardiothoracic Surgery at Max Hospitals, Dr. Harit Chaturvedi, who is a Onco Surgeon and the Director of Onco Surgery at Max and Dr. Anupama Hooda, who heads the medical oncology practice at Max. We had a packed house, a very interactive audience and some very interesting discussion.

I have known Dr. Buddhiraja for many years. He is a founding member at Max Healthcare, we worked together for almost 5 years, when I handled the Marketing function at Max. He continues to be my physician and has on numerous occasions treated many members of my family. In all these years I have known him to be a quiet, sincere and thorough professional, somebody whom you can implicitly trust. Today, I discovered another facet of Dr. Buddhiraja, that of a fiery crusader against tobacco abuse. Sandeep, had come prepared with all the facts, which pointed to a huge burden of disease, that is caused by tobacco abuse. He spoke with great passion, while talking about the harmful effects of tobacco. He is clearly much distressed about the increased use of tobacco in its myriad forms, cigarettes, gutkhas, chewing tobacco, pan masala, snuff etc., which is being impudently hawked on our streets. ”On one end of a cigarette is fire and ash and on the other a moron”, is how Sandeep succinctly put it.

Dr. Virdi, made a simple point saying that you can trace almost any lifestyle disease today to tobacco. Be it heart disease, peripheral vascular disease, a stroke and oral and lung cancers, tuberculosis of the chest, all of them are linked to tobacco. This hit home much closer, and I wondered aloud about my father’s illnesses in his almost 60 years as a smoker. He has had tuberculosis twice, a stroke last year and is currently battling with an oral cancer. So much for a puff!!!

Dr. Chaturvedi and Dr. Hooda had a field day, with oral, lung and other cancers having a clear association with tobacco. They too are passionate doctors and see enough and more cancer victims every day, who would be healthy, if only they had stayed away from tobacco. One can feel their pain and if I may say anger at young people not realizing the grave danger of abusing tobacco, till they reach the office of an oncologist. Dr. Chaturvedi, wondered how is it that once someone is diagnosed with oral cancer, he gives up smoking without missing a beat. My father kicked a 60-year-old habit, the day we told him about his cancer, incidentally diagnosed by Dr. Chaturvedi himself. He wondered that giving up tobacco can not be all that hard.

Dr. Samir Parikh is one of those irrepressible live wires, who have a view on almost everything. Being a psychiatrist and that too one of the most well-known in Delhi, Dr. Parikh counsels and works with lots of people struggling with substance abuse including tobacco abuse. Dr. Parikh and Dr. Buddhiraja talked about how and why one starts with tobacco. Peer pressure, cultural shibboleths including smoking being ”cool”, and myths like ”I can quit anytime”, came up as the most prominent reasons for most people lighting up. Samir and Sandeep, both were emphatic in their pronouncement that tobacco abuse is not merely a habit but a disease. They cited ICD classifications on nicotine abuse and gave medical reasons for nicotine addiction and elaborated on the treatment that can help one kick the disease. They run a tobacco cessation clinic at Max Healthcare and work with smokers, who are keen to quit, but find it hard to get rid of the problem.

My colleague Saurabh Avasthi, who smoked 30 cigarettes a day and then gave up one fine day in October last year also spoke about how he started and how steadily tobacco caught him in its vise like grip and how one day, he just decided that enough was enough. He said that he symbolically buried cigarette sticks and then just never lit up again. The first ten days were hard, when the pull of nicotine, was at its worst and he would count his smoke free days. Over a period of time, he realized that the urge no longer existed and now he says that the stench of tobacco nauseate him.

In the final analysis we concluded that there is no running away from the fact that even one cigarette per day is really one too many. In over 150 people, who attended today’s panel discussion, even if one decides to give up tobacco as a result of today’s session, I would reckon, we would have achieved a lot.

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When did you visit a hospital last and found a process, which made you sit up and take serious notice?

Hospitals in India are crying for serious innovations, yet we see so little of them. While, one keeps hearing about mind-boggling advances in medicine and technology, yet very little of that is reaching our hospitals. The largest and the most modern hospitals in India at best pay lip service to serious innovation. They do not even have innovation teams, which can identify and adopt innovative practices, which help cure faster, keep people healthy and provide a better customer experience at the hospital.

The reason for this are not far to seek.

Healthcare services in India are still in their infancy. While, large hospital chains like Fortis, Apollo and Max Healthcare have the latest equipment and the most sought after doctors, they are still not customer focussed. Innovations happen, when the customer is the focus of the organisation. Our healthcare services organisations are still mired in pandering to the egos of their senior doctors, guarding them like mother hen, lest they fly the coop. Since, there are only so many ‘star doctors’ and they are mostly responsible for pulling in the patients, one can not really fault the hospitals for focusing on their crown jewels rather than on patients. To make matters worse, most of these star doctors are older, quite often set in their ways, it is virtually impossible to make them innovate. They are wildly successful individuals, who have been at the top of their game for many years and see no reason to do things differently. Thus, in a Max Hospital in Delhi, you will have the younger doctors, using the Hospital Information System, the older and more senior ones, would still prefer a pen and paper, mindless of the fact that this means that every-time the patient comes to visit them, he would be carrying the past prescriptions and records in a file. And, this when Max has spent a fortune in putting in place a state of the art HIS!!!

The other driver of innovation is competition, which in the Indian context is sadly lacking. While, there are millions of mom and pop nursing homes and down the street clinics, good hospitals are few. With India growing close to 9%, many Indians can now afford good quality healthcare services. With health insurance also contributing its might, we have a situation, where there are too many patients chasing too few hospital beds. As the economy grows further and we see the benefits of our growth percolate down deeper, people would continue to move up from small and dodgy nursing homes to swanky, well organised hospitals. Thus, at the top end of the Indian healthcare market, serious competition is a long way off. This does not augur too well for healthcare innovations.

Health Insurance companies can drive serious healthcare innovations. They are always on the lookout of shaving costs and innovations often do that. However, in India, health insurance is still largely controlled by the state-owned general insurance behemoths, whose health insurance portfolio is a tiny fraction of the general insurance business that they handle. They themselves are riddled with inefficiency and corruption and can hardly be expected to drive healthcare innovations. The standalone health insurance companies in the private sector are still wobbly and are trying to find their feet. They too are quite clearly a long way off from driving innovations at our hospitals.

The only way we can possibly drive innovation in healthcare services in India is by becoming more demanding as patients. Impatient patients can bring about change in the delivery off at least the non medical services at our favourite hospitals. Thus, if a doctor is running late with his OPD appointments, patients can ask the hospitals to send sms’s in advance to patients, who are scheduled later in the day. If the hospital queuing system is inefficient, a patient can always suggest another system, which works better. (Check-out the new system at Max Medcentre in New Delhi, it is simple and efficient).

As far as bigger innovations are concerned, the hospitals and their various stakeholders have to drive those. Change inevitably brings pain in the shorter run, however those organisations, who have their eyes set on the horizon, cannot but embrace change. Even though, in India, the external circumstances may not be very conducive to innovations, we must remember, all great innovations are internally driven, largely rooted in a desire to be more efficient, more customer friendly, more differentiated and more profitable.

Indian hospitals must innovate to compete with themselves and to be better than what they were yesterday. That is the only way to long-term success.

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Last week I came across a piece by Sopan Joshi in Tehelka. The story titled ‘No Place to be Sick’ (http://www.tehelka.com/story_main48.asp?filename=Ne050211coverstory.asp) appears to be a shallow piece intent on maligning private healthcare in India. Mr. Joshi’s central point ‘even if you could afford it, a private hospital may be the last place you would want to be in’ is completely flawed. While Mr. Joshi, cites a case of a cancer patient, who died at Max Hospital in New Delhi, after receiving chemotherapy, quotes the relatives and employers of the deceased, who believe that the hospital knowing well that the patient was unlikely to survive went ahead with chemotherapy and ran a bill of close to Rs. 8Lacs, which coincidentally was close to the insurance limit enjoyed by the patient. Basically Mr. Joshi is saying that Max Hospital unnecessarily treated a dying man because they wanted to make money.The hospital of course has denied the charge.

Now here is my point, who decides whether a patient should be treated or not? Isn’t it the job of his doctor to take this call? Isn’t the patient and his caregivers supposed to trust their doctors and if they do not trust the hospital or the doctor, isn’t it best that they find another doctor or a hospital for their treatment. In my many years in hospitals, I have seen patients and their attendants asking the doctors to do whatever they can to save a life of a loved one, they beg and plead that the doctors do something, anything to prolong a life. Now if the doctors, try something and the outcome turns out to be negative, how correct it is to say that the hospital deliberately over-treated just because it is a commercial enterprise and making money is in its DNA. Suppose in this particular case, had the doctor turned away the patient, wouldn’t that have left him open to the charge of not admitting and treating a seriously ill patient because no hospital wants a high mortality rate. From the hospital’s perspective this really is a catch 22 situation.

It is not my case that private healthcare services in India are perfect. They are not. However, by highlighting stray cases of wrong diagnosis and hospital borne infections, Mr Joshi can hardly make a sweeping conclusion that all private healthcare in India is driven by greed and little else. While, I would be the first to admit that there are many hospitals, who try to fleece patients it certainly does not mean that most private healthcare service providers are out to rob the patients blind. In fact corporate hospital chains like Max, Apollo and Fortis (to name a few) are trying hard to provide world-class healthcare services and while they are expensive by Indian standards, they still are amongst the cheapest in the world.

The problem with private healthcare in India is that it is completely amorphous and unregulated. While there is world class medical services being offered by some hospitals, there are millions of mom and pop shops, usually owned by a doctor and his family, which also provide healthcare services. These so-called nursing homes usually have very basic facilities and since they are completely unregulated, they get away literally with murder. This huge underbelly of private healthcare in India is the soft spot, which the government needs to fix immediately. To make matters worse, the average Indian consumer knows very little about his rights as a patient and is too overawed by the highly educated, English sprouting doctors to ask too many questions and ends up getting a raw deal. What we really need is a much more organised and accountable healthcare services.

Let us now look at what the government has to offer. In the city of Delhi, the government owns many hospitals, which are all large tertiary care centres. These are incredibly filthy, overcrowded (often two patients on a bed), stinking and staffed with callous government employees, who care two hoots about a patient. The doctors, while extremely competent, are under such a huge workload that its is just not humanly possible for them to provide good quality care to so many. My words may seem harsh, but the reality is much worse. Most people seeking care in the government-run hospitals use their ‘contacts’, with the powers that matter, to secure a bed and a surgery for themselves. In smaller towns and cities the situation is much worse, with the district hospitals being poorly equipped, saddled with obsolete equipment and with doctors who consider their responsibilities as punishment postings.

The solution really lies in a Public Private Partnership and increased regulation. We must have a healthcare services regulator (pretty much like the insurance or telecom regulator), who should lay down guidelines and rules for private and public hospitals and ensure that these are stringently followed. Hospitals outcomes, its systems and processes and its people must be periodically audited for quality. The regulator should be empowered to act without fear or favour to weed out the laggards and the unscrupulous.

And now to revert to Mr. Joshi again, let me ask a simple question, God forbid if he or someone in his family needs a hospital, where will he go-to a private hospital or to a government-run public hospital? To me the answer is quite obvious, we need more Max, Fortis and the like.